TY - JOUR
T1 - Improving outcomes at Level I trauma centers
T2 - An early evaluation of the trauma survivors network
AU - Castillo, Renan C.
AU - Wegener, Stephen T.
AU - Zadnik Newell, Mary Beth
AU - Carlini, Anthony R.
AU - Bradford, Anna N
AU - Heins, Sara E.
AU - Wysocki, Elizabeth
AU - Pollak, Andrew N.
AU - Teter, Harry
AU - Mackenzie, Ellen J.
PY - 2013/6
Y1 - 2013/6
N2 - BACKGROUND: The Trauma Survivors Network (TSN), a program developed to help patients and families manage the psychosocial impact of their injuries, combines information access, self-management training, peer support, and online social networking. The purpose of this study was to evaluate the effectiveness of the TSN in improving patient reported outcomes among orthopedic trauma patients at a Level I trauma center. METHODS: We prospectively enrolled 251 patients with either severe lower-extremity injuries or polytrauma in two cohorts: one group (n = 125) before implementation of the TSN and one group (n = 126) after implementation. Participants were interviewed during their initial hospital stay and at 6months. Outcomes evaluated at 6months included depression, anxiety, self-efficacy, health status, and patient activation. RESULTS: Participation in the individual components of the TSN was low, ranging between 3% for the NextSteps self-management program and 27% for receipt of the Patient and Family Handbook. There were no statistically significant differences between treatment and control groups in self-efficacy, anxiety, health status, or activation. There were statistically significant differences in depression (24% of patients with probable depression in the TSN group vs. 40% in the control group, p = 0.02). However, the groups were not balanced with respect to sex, education, and baseline social support. After controlling for these differences, the TSN group still had 49% lower odds (95% confidence interval, 0% to 74%) of depression ( p = 0.05). CONCLUSION: The TSN represents a potentially important step toward the development of comprehensive psychosocial support programs for trauma survivors. Despite improvements in one important outcome, a key finding of this evaluation is the low rate of use of program components. This finding highlights the need for greater understanding of use barriers and efforts to increase adoption. LEVEL OF EVIDENCE: Therapeutic study, level IV.
AB - BACKGROUND: The Trauma Survivors Network (TSN), a program developed to help patients and families manage the psychosocial impact of their injuries, combines information access, self-management training, peer support, and online social networking. The purpose of this study was to evaluate the effectiveness of the TSN in improving patient reported outcomes among orthopedic trauma patients at a Level I trauma center. METHODS: We prospectively enrolled 251 patients with either severe lower-extremity injuries or polytrauma in two cohorts: one group (n = 125) before implementation of the TSN and one group (n = 126) after implementation. Participants were interviewed during their initial hospital stay and at 6months. Outcomes evaluated at 6months included depression, anxiety, self-efficacy, health status, and patient activation. RESULTS: Participation in the individual components of the TSN was low, ranging between 3% for the NextSteps self-management program and 27% for receipt of the Patient and Family Handbook. There were no statistically significant differences between treatment and control groups in self-efficacy, anxiety, health status, or activation. There were statistically significant differences in depression (24% of patients with probable depression in the TSN group vs. 40% in the control group, p = 0.02). However, the groups were not balanced with respect to sex, education, and baseline social support. After controlling for these differences, the TSN group still had 49% lower odds (95% confidence interval, 0% to 74%) of depression ( p = 0.05). CONCLUSION: The TSN represents a potentially important step toward the development of comprehensive psychosocial support programs for trauma survivors. Despite improvements in one important outcome, a key finding of this evaluation is the low rate of use of program components. This finding highlights the need for greater understanding of use barriers and efforts to increase adoption. LEVEL OF EVIDENCE: Therapeutic study, level IV.
KW - Program evaluation
KW - Self-management
KW - Trauma
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U2 - 10.1097/TA.0b013e3182921606
DO - 10.1097/TA.0b013e3182921606
M3 - Article
C2 - 23694884
AN - SCOPUS:84880084503
SN - 2163-0755
VL - 74
SP - 1534
EP - 1540
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 6
ER -